Form 521 - Filing Form Cover Letter Page 5
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7By signing and submitting this form to the Ohio Secretary of State, the undersigned hereby certifies that he or she
has the requisite authority to execute this document.
Required
Signature
Agent update must
be signed by an authorized
representative (see
instructions for specific
By
information).
If authorized representative
is an individual, then they
must sign in the "signature"
Print Name
box and print their name
in the "Print Name" box.
If authorized representative
is a business entity, not an
individual, then please print
Signature
the business name in the
"signature" box, an
authorized representative
of the business entity
By
must sign in the "By" box
and print their name in the
"Print Name" box.
Print Name
Form 521
Last Revised: 05/14/2014
Page 5 of 7
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